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protocol. The inconsistency in question was the patients inability to meet the
expected outcome of taking ten breaths per minute during the shift. Therefore,
the patient centered goals were revised to focus on the possibility of and
success of organ donation.
Nursing Practice
Applies appropriate knowledge of major health problems to guide nursing practice
Example: Near the beginning of the clinical case study, there is a Medical
Diagnosis section in which the patients diagnosis of self-inflicted
penetrative brain injury is identified and thoroughly described. In this
section, the pathophysiology of this diagnosis was explored, which laid
groundwork for making the nursing diagnoses. When evaluating the
pathophysiology of the medical diagnosis, I recognized that his injury was
actually a perforating brain injury, as the bullet travelled completely through
the brain and out of the other side of the skull. If it were a penetrating brain
injury, the bullet would have stayed imbedded in the brain matter. This
actuality served to be important when evaluating the damage endured by the
patient. Knowledge about respiratory failure and tissue perfusion was also
applied in depth in this paper.
Performs therapeutic interventions that incorporate principles of quality
management and proper safety techniques based upon assessment findings
Example: As a requirement of this paper, therapeutic interventions applied
when caring for the patient had to be identified for the top two nursing
interventions. These interventions were based on head-to-toe assessment
findings when caring for the patient and were based off of providing quality,
holistic, and safe care. Interventions applied to this patient included
dependent, collaborative, and independent nursing interventions.
Collaborative and dependent interventions for the primary nursing diagnosis
of ineffective breathing pattern included intubation and ABG draws, as nurses
collaborate with the respiratory therapists when accomplishing these tasks and
nurses depend on the physician to intubate the patient and to order ABG
draws. Independent interventions included close monitoring of lung sounds,
respiratory rate and oxygen saturations as well as raising the head of the bed
and suctioning excess respiratory secretions. Examples of safety techniques
implemented for this patient included raising the head of the bed to prevent
aspiration, providing oral care every four hours to prevent ventilator
associated pneumonia, and using aseptic technique when accessing central and
peripheral lines (per hospital protocol).
Implements traditional nursing care practices as appropriate to provide holistic
health care to diverse populations across the life span.
Example: Traditional nursing care practices discussed in this case study
included continuous assessments, medication administration, mechanical
ventilation, oral care, suctioning, central venous access, preventing infection,
fluid resuscitation, and others. The patient was young adult. The family
included adolescents and middle-aged adults.
Communication
Produces clear, accurate, and relevant writing using correct grammar, spelling, and
punctuation.
Example: When graded on this paper by my clinical faculty, I received all
available points for Writing Style which included grammar, spelling,
punctuation and language. The comment in the grade rubric read, Very well
organized and logical flow. This shows that I have accomplished this
requirement through the development of this case study.
Teaching
Provides teaching to patients and/or professionals about health care procedures and
technologies in preparation for and following nursing or medical interventions
Example: As a requirement, education provided to this patient during the
clinical experience had to be identified for the top two nursing diagnoses. All
of the education was provided to the family in this case, as the patient was
unresponsive throughout the entire time he was in the hospital. Most of the
teaching was focused on anticipatory guidance for the family regarding
procedures, brain death testing and organ donation. As identified in the case
study, the family was not ready to be taught about physiological processes that
the patient was going through, as the family was grieving at that time.
Provides relevant and sensitive health education information and counseling to
patients, and families, in a variety of situations and settings
Example: The relevant and sensitive health information provided to this
patient as identified in the case study as regarding organ donation. The nurse
and I participated in the discussion with the family provided by LifeNet and
the physician regarding specificities about how the patient was determined to
be brain dead and about how valuable the patient was in terms of organ
donation. Because these are very sensitive topics, this discussion was done in
a private room with the chaplain nearby.
Research
Differentiates between descriptive nursing literature and published reports of nursing
research
Example: As a requirement, there were to be three research articles included
in this case study. Two of the research studies included were nursing research
articles. Also included were non-research types of literature including books
and articles describing the protocols of the facility in which the patient was
staying. One of the two nursing research articles was about noninfectious
hyperthermia in brain-injured patients, and the other was about the
optimization of organ procurement with certain medication administration.
Culture
Demonstratessensitivitytopersonalandculturaldefinitionsofhealth,andhowthese
beliefsinfluenceanindividualsreactionstotheillnessexperienceandendoflife.
Example:DuringthetimeIhadwiththepatientdiscussedinthecasestudy,I
demonstratedsensitivitytothepersonalandculturaldefinitionsofhealthof
thepatientsfamily.Asidentifiedinthepaper,oneparticularexampleofthe
differentdefinitionsofhealthandreactionstodeathwasexhibitedbythe
patientsmother.Themotherverbalizedtomeandthenursethatshewas
angryaboutallofthetubesandlinesthatwerestillattachedtothepatient
afterhewasdeclaredbraindead.Sheunderstandablywantedthemremoved
assoonaspossible.Anger,thesecondstageofgriefresultingfromillnessand
endoflife,wasdisplayedatthistime.Culturally,shefeltasthoughthepatient
wasnotabletoputtorestuntilhewasdetachedfromthemachines.So,she
wassensitivelytaughtthatsincetheyhaddecidedtogoalongwiththeorgan
donationprocess,thelineswouldhavetobeleftattacheduntilaftertheorgans
wereharvested.Furthermore,thenurseandLifeNetprofessionaldidtheirbest
toensurethattheorganprocurementwastotakeplaceassoonaspossiblein
ordertoreducethisdiscomfortexpressedbythemother.